TMA 01 Summarise and discuss the presentations of mental health in the two newspaper articles given in Appendix 1. (1500 words). 1. Summaries of cited media “Tackling Mental Health Problems in a Downturn” (Gill, Trevelyan, The Times, 30th September 2009) This article, written by the Head of Good Practice at ACAS, suggests that despite the difficulties in accurately diagnosing mental health problems, the government has calculated that mental health related sickness is costing the UK economy ? 26 Billion per year.
This is increasing during the economic downturn, primarily due to the fear of loss of jobs. Consequently, government agencies are working with employers to help reduce the causes of mental health, including the Health and Safety Executive who have introduced management standards to reduce stress at work. Conclusion ??? “there needs to be a big attitude change in the way we view mental health…… given that up to 1 in 4 will suffer from mental health problem…. it is an issue workplaces can no longer ignore”.
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Stiff Upper Lip Culture blamed as British men top the Euro depression league. (Jenny Hope, Daily Mail 1st May 2008). A study of mental illness in six countries, by Professor Michael King, found that the rate of major depression and panic syndrome was highest among males in the UK. Professor Cary Cooper from British Association of Counselling and Psychotherapy, suggests traditional British cultural patterns and long working hours means men are less able to talk about their problems than women or express their emotions so become less emotionally intelligent than women.
Mental illness and stress are now the most common reasons for claiming incapacity benefit, but there is effective treatment available for depression and anxiety. 2. Further discussion Some areas of the media are suggesting that after Swine Flu, the UK is facing a new threatening pandemic, depression and stress. Alarming statistics, like those above, appear to substantiate this narrative. Society is turning to medical and pharmaceutical bodies to offer miracle cures. This essay will challenge some of these notions. Firstly, this is very much a global, not national issue.
In a World Health Organisation (WHO) report in 2002, it states: ??? 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. ??? About 877,000 people die by suicide every year. ??? In south Asia, the number of people who commit suicide is higher than the number who die because of road accidents, terrorism and HIV/Aids. It is among the top three causes of death in the population aged between 15 and 34. ??? Mental illness will be the second biggest cause of death and disability by 2020
So what has caused this epidemic? Engel (1977) advocates the bio psychosocial model, where biological, psychological and social factors systemically react in creating the mental state. It could be argued that the theory in Chapter 4 of D120 course reader, that industrialisation has caused a self-destruction as people have been “wrenched from the land …. and forced into abstracted conditions of living in the capitalist economy”. The high suicide figures in South Asia arguably could therefore be linked to the area’s fast economic and industrial growth.
Brown, Harris and Hepworth (1995) state that misery has been linked to loss of some kind. Possibly, one of the links between the economic downturn and increasing levels of mental illness featured in the 2nd news article, could be the ultimate fear of the loss of a job and the associated material trappings. However, there is not inconsiderable controversy about the diagnoses of exactly what constitutes depression ??? Winnicott (1988) for example argues depression and anxiety are just part of life, “….. robably the greatest suffering in the human world is the suffering of normal or healthy or mature persons. “. Brown, Harris and Hepworth (1995) go so far as to say that misery is recognisable in other animals and is not an exclusive human condition. Recent history of mental health highlights the Victorian perspective of a “mania and melancholia’ model, where mental disorders are separate, naturally occurring categories, often genetically determined (Kraepelin, 1883). This was a perspective based on eugenics ??? i. . it was only the chronically poor who suffered mental health issues. This perspective was challenged when society was faced with officers returning from the trenches of World War I suffering from shellshock. Possibly from that moment there was an underlying wish in society to diagnose and categorise different forms of mental illness and to make them medical issues. Freud opposed this medical model in 1926 arguing for the right for ‘lay analysts’ to practice psychoanalysis rather than trained doctors.
The categorisation of mental illness continues today with 2 main publications, the International Classification of Diseases (ICD) created by the World Health Organisation and the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association. This form of categorisation facilities the process of medical treatment of the patient, by standardising the referral process between medical practioners and the diagnostic labels are primarily used as a, “convenient shorthand” among professionals and not for lay use”.
Possibly some of the increase of recorded mental health cases may be linked to the growth of categories available to medical practioners. The first publication of DSM in 1952 had 106 recorded mental disorders, by 1994, in the fourth publication the number of disorders had risen to 297. The validity and reliability of such diagnoses are crucial, questioning the reality of the diagnoses and if they are consistent between practioners. In a study of 50,000 cases, Dr Alex Mitchell (2009) identified that many G. P. s have, “…. reat difficulties in separating those with and without depression, with substantial numbers of missed and misidentified…. In the worst case scenario false diagnoses could outnumber true diagnoses three to one. ” Rosenhan (1973) challenged validity by with an experiment where health professionals could not differentiate between some healthy subjects and mentally ill patients. The validity has been further questioned through the objectivity of the experts on the DSM panel. In the University of Massachusetts publication, Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry (Krimsky 2006).
A study of members of the 170 panel members who contributed to the diagnostic criteria in the DSM, 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. 100% of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. Further questions about the powerful influence of the pharmaceutical industry are raised in the New England Journal of Medicine publication The Trap: What Happened to Our Dream of Freedom (Erick H. Turner, et al).
The US Food and Drug Administration (FDA) commissioned studies of 12 antidepressant agents involving 12,564 patients. ??? 74 FDA-registered studies (31%) were not published. ??? 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. ??? 22 of 25 studies that the FDA viewed as having negative or questionable results were either not published or were re-published in a way that conveyed a positive outcome. ??? According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. ??? Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall. The conclusion of the report was, “Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients”. The risk then follows that the influence of marketing by pharmaceutical companies can create the perception for those suffering, that chemical intervention is the answer.
Indeed there has been a steep growth in the use of anti ???depressant pharmaceuticals, during the recent economic downturn: The Guardian reported, ” [In 2008] 36m prescriptions [of anti depressants] were given out, an increase of 24% over the past five years”. In the article Phillip Hodson, a fellow of the British Association for Counselling and Psychotherapy, said, “I have every sympathy with GPs who are pressed into prescribing them, it’s what their patients want. Doctors want to be liked, they don’t want to be unpleasant but sometimes tough love is a better idea. ” Conclusion
Despite there still being clear dispute about how they diagnosed and categorised, there is wide clinical and anecdotal evidence that depression and anxiety are a growing problem in societies throughout the world. There is a possible inevitability that some people will suffer from some kind of mental distress at some point in their lives, but it appears that the worries caused by the social pressures in the current economic climate are exacerbating the problem. In response to this trend, in recent times there has been an increase in the recognition of mental illness and help and support for those suffering.
Centralised approaches to categorisation can allow some comfort to the individual, but there is a consequent risk that the ‘medicalisation’ of treatment offers a perceived quick fix to mental illness rather than addressing underlying causes. Psychoanalysis, or Cognitive Behaviour Therapy, can offer help as a more holistic, longer term form of talking cure. , by looking at each persons situation individually rather than as part of a formatted case. References: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed. ). Washington, DC: APA.
Antidepressant use soars as the recession bites, Jamie Doward, The Observer, 21st June 2009. http://www. guardian. co. uk/society/2009/jun/21/mental-health-antidepressants-recession-prescriptions . Accessed 12th June 2010. Brown, G. and Harris, T. (1978). Social origins of depression: A study of psychiatric disorders in women. London: Tavistock Publications. Kraepelin, E. (1883). Compendium der Psychiatrie. Leipzig. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129???136. Krimsky 2006) Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry
Mitchell, Vaze and Rao (2009) Clinical diagnosis of depression in primary care: a meta-analysis, The Lancet August 2009; http://www. ncbi. nlm. nih. gov/pubmed/19640579 Accessed 12th June 2010 D. L. Rosenhan; On Being Sane in Insane Places, Science, New Series, Vol. 179, No. 4070. (Jan. 19, 1973), pp. 250-258. http://hlmoon. com/docs/2312_week11_reading2. pdf Accessed 12th June 2010 Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy Erick H. Turner, M. D. , Annette M. Matthews, M. D. , Eftihia Linardatos, B. S. , Robert A. Tell, L. C. S. W. , and Robert Rosenthal, Ph.
D http://content. nejm. org/cgi/content/short/358/3/252 (Accessed 12th June 2010) Winnicott, D. W. (1988). Human nature. London: Free Association Books. World Health Organisation; Mental Health, http://www. who. int/mental_health/en/. Accessed 12th June 2010-06-12 What was interesting? I found this interesting when researching further into the validity of mental health diagnoses, the impact of the pharmaceuticals and thinking what is an illness? What was challenging? I found squeezing such a complex argument into a short essay whilst keeping an objective narrative very challenging.